On the New Health Dialogue blog, Paul Testa analyzed the ongoing public debate about comparative effectiveness research:

The New York Times‘ Robert Pear examines the content and contentiousness of the comparative effectiveness provisions of the $787 billion stimulus package. HR 1 provides $1.1 billion (pdf starting on page 156) to AHRQ, NIH and the HHS to evaluate the relative effectiveness of different health care services and treatment options. The goal is to create a process of funding and disseminating comparative effectiveness research that is transparent, professional and free from conflicts of interests. As the Dartmouth Atlas’ Elliott S. Fisher, MD, tells Pear, the funding would be used to try to answer questions such as:

… What is the best combination of “talk therapy” and prescription drugs to treat mild depression?
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Is it better to treat chronic heart failure by medications alone or by drugs and home monitoring of a patient’s blood pressure and weight?

In health care, though, simple questions rarely have simple answers. Nor will answers be static; biomedical science changes at a pretty astonishing clip. We wrote about this topic twice last week, and we expect to hear more about it as the health reform debate intensifies. Last week Kyle Noonan wrote about some of the alarmist rhetoric surrounding the issue, and Joanne Kenen wrote a longer piece about how comparative effectiveness fits into “health” as well as health care reform. We also want to point out Bob Laszewski’s posts at the Health Care Policy and Market Place Review, which has provided interesting coverage on this topic.
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Beginning to measure what works best for what patients or populations under what circumstances can provide a baseline. Providers and patients will have access to information that will help them better understand their choices and the likely consequences. Providing that information in a manner that is transparent, credible, and easily understood will go a long way to ensuring that all Americans receive the most effective care whether they live in Florida or Nebraska or California.

At Science-Based Medicine, Peter Lipson shared his perspective on comparative effectiveness research:

In my last post, I told you a little story about using science- and evidence-based medicine to improve health care… A researcher came up with a plausible idea for an intervention, studied it, and found it to be successful… But we don’t really have an easily accessible repository of evidence-based interventions. Every field has its own standards, its own literature, and its up to each individual practitioner to interpret the data on their own… and while we follow evidence-based guidelines in much of our care, there are many times when evidence isn’t just hard to find but is actually unavailable.

Give our “evidence gap,” I was heartened to see this story in the New York Times. The Times reports that the economic stimulus bill will include over a billion dollars to fund research into medical evidence. This is a good thing, but it’s bound to be controversial… there’s a lot of predictable objections about this; people are worried about physician autonomy and government interference.

… Republican lawmakers and conservative commentators complained that the legislation would allow the federal government to intrude in a person’s health care by enforcing clinical guidelines and treatment protocols.

And so what? Right now, my patients’ insurance programs do exactly the same thing…

If we have more evidence to work with, we can continue to make even better decisions regarding care. It may seem intrusive, but it’s not very different from what we do already. And honestly, I’d like to know if I’m more likely to get relief of my lumbar radiculopathy from surgery or from conservative therapy… It rings rather hollow when people protest against gaining more knowledge… Once we have the data, we can sit down for a good, heated discussion about what to do with it. But putting our collective heads in the sand is probably not a useful response.

On his HealthBlawg, David Harlow discussed one of the health IT provisions of the stimulus package President Obama is expected to sign today:

One of the many stimuli included is the HITECH act, a $19 billion electronic health records funding provision. This sort of action by the federales was long promised by Obama on the campaign trail: spending federal dollars to jump-start the leveraging of technology in order to improve health care quality at lower cost.
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On the one hand, it’s designed to subsidize EHR adoption by physician practices and hospitals that otherwise might not be able to afford them (to the tune of up to $40K per doc). To the extent that we believe that EHR adoption will promote efficiencies in excess of their costs (and yes, you do detect a note of healthy skepticism), that’s a good thing. On the other hand, it will almost certainly result in further entrenchment of current market leaders, to the possible detriment of providers and patients who do not necessarily need the high-cost offerings now on the market that are characterized by some observers as having limited “data liquidity” — which, if we’re looking for interoperability, is a key thing to have.
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There’s an awful lot of money on the table. Let’s hope that it can be spent wisely, on a variety of approaches to an intractable problem: the wiring of this country’s health care providers for the benefit of their patients and the collective fisc.

In the Think Progress Wonk Room, Igor Volsky covered a new Wonk Room report:

Some new figures out on the surge in the number of Americans losing health insurance:

The final stimulus package, which the President is scheduled to sign later this afternoon, includes a fair number of health provisions. Yet it’s not a total victory for progressive health advocates. In the run-up to the passage last week of the American Recovery and Reinvestment Act, negotiators compromised on some key health components… even as millions of Americans were losing their jobs and health insurance. In fact, according to a forthcoming analysis by James Kvaal and Ben Furnas, as the unemployment rate grew by 0.8 points in December and January, nearly 100,000 people a week or 14,000 people a day lost their health coverage:

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The ranks of the uninsured will grow as the recession persists, in spite of conservative obstructionism. As Jacob Hacker points out, the stimulus “won’t provide the cure. What we need is a new New Deal.”

On that note, the National Journal Health Care Experts blog asked about the degree to which the stimulus package could help newly unemployed and uninsured Americans, pointing out:

• It includes $87 billion in federal money to help states with Medicaid.
• It subsidizes COBRA premiums at 65 percent for people who want to continue coverage from their previous employer.
• It does not temporarily open Medicaid to unemployed workers who lose their jobs.

American Medical Association President Nancy H. Nielsen responded:

In this tough economy, expanding Medicaid and COBRA benefits is a necessary stop-gap measure. It’s hard enough to be unemployed; we don’t want the unemployed to also be uninsured. The investment in the safety net through more support for Medicaid will maintain the program that cares for some of our most vulnerable populations… Short-term COBRA premium assistance for the unemployed will keep health insurance coverage in reach for many people who lose their jobs.
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These temporary extensions of health care benefits during this time of economic turmoil, however, represent only the first step in a long process to meet a persistent national need. We must continue to work together on comprehensive health system reforms to ensure that all Americans have access to high-quality, affordable health insurance.

Center for Health Transformation Founder Newt Gingrich shared a different perspective:

The stimulus legislation is like putting a band-aid on a heart attack: It does very little to address the fundamental problems we face in health. Consumers will still find barrier after barrier to getting insurance coverage if they lose it… States will be back in the exact same predicament when the bailout money runs out. What we need to do is not throw good money after bad, but address what governments can and should be doing differently that will help get us out of this spiral.

Government should provide the framework for everyone to obtain health insurance… Governments at all levels should prioritize, measure, and incorporate successful models into their public programs and through their role as employers… Government should be flexible in providing new opportunities for states to expand insurance coverage and access to high-quality, cost-effective care.

Until we make real changes to allow the private market to actually work along side effective, quality-centered public programs, bailouts will be the norm, not the exception.

Finally for this week, the findings of a Nurses’ Health Study are good news for coffee-drinking women, as The Women on the Web reported:

Coffee drinking can be good for you. A new study found that women who drink four cups of coffee a day can reduce their risk of stroke by 20 percent compared to women who drink less than one cup per month. Women who drink two to three cups every day reduce their risk by 19 percent and women who drink five to seven cups a week reduce risk by 12 percent.
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Caffeine doesn’t appear to be behind the reduction, since researchers found that women who drink tea and caffeinated soft drinks didn’t enjoy the same reduction in strokes. “This finding supports the hypothesis that components in coffee other than caffeine may be responsible for the potential beneficial effect of coffee on stroke risk,” said Esther Lopez-Garcia, lead author of the study and assistant professor of preventive medicine at the Universidad Autonoma de Madrid, Spain, in a news release. “Antioxidants in coffee lower inflammation and improve blood vessel function.”

This entry was posted on Tuesday, February 17th, 2009 at 3:48 pm and is filed under Consumer Health Care, Insurance, Medicaid, Policy, Politics, Quality, Roundup, Technology, Women's Health. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.